The HCAHPS Approach

Adobe stock photo

Adobe stock photo

There is a problem on the floor. Not the literal floor. I mean the medical-surgical hospital floor that I work on. And every hospital floor, for that matter.

I have named this problem “the HCAHPS approach.”

For those who are not in the healthcare profession, let me briefly explain. HCAHPS [pronounced H-caps] stands for Hospital Consumer Assessment of Healthcare Providers and Systems. When patients leave the hospital, they receive a 32-question survey asking them to rate various aspects of their care. Examples include how quickly their call lights were answered, whether nurses and doctors treated them courteously, and even how quiet the halls were at night. The idea is to measure quality of patient stays and not just quantity, which is a good thing in of itself.

Here’s the catch. Hospitals’ reimbursement is linked to HCAHPS scores.

I could go on and on about the flaws in the system (like have you ever noticed the people who have dissatisfied are the ones who are more likely to complete surveys?), but that’s beside the point.

Broken system or not, I can tell you the effect it has on the hospital floor. Nurses and other staff are more stressed out, feel pressure to perform, and are always trying to please everyone, even when patients' demands are unreasonable. Hospital units track scores, huddle over scores, post graphs of scores. Sometimes we even talk about which patients wouldn’t give us a high score during shift change huddle. You would be amazed at how much time, money, and effort goes into trying to improve patient satisfaction scores.

But then again, maybe we shouldn’t be amazed. 

It’s Everywhere

When I look around myself—and more importantly, when I look within myself—everything I just described is present: high stress level, pressure to perform, working to please everyone…

Toward the beginning of this year, I sat across from my therapist and told her I felt like I was on a treadmill of perfectionism. I kept running and running and running, trying to go faster and work harder and be better, but I was getting nowhere. It was only exhausting me and made me feel like a failure.

I was applying the HCAHPS approach to life—and so is a large portion of society. We pressure ourselves and others to perform, and we measure our self-worth by what other people think of us. Many of us openly admit to being “people pleasers.” (The opposite response is also dangerous—dismissing everyone’s opinion and deciding not to care about what anyone thinks, even if they have valuable feedback. But that’s a whole different topic for another day.)

Though there’s nothing inherently wrong with ensuring quality patient care and assessing how others feel about us, there is a fine line between assessing and obsessing

When satisfying others and controlling their perception of us becomes the focus, toxic environments are created. That toxic environment can exist inside ourselves, in our work places, in our homes, etc.

Why It’s Toxic

When our whole focus is on what others think, we operate from a belief that we are not enough and maybe if we try harder, are nicer to that co-worker, answer that patient’s call light faster, we will be enough. We believe we will get all top scores and everyone will love us and we will feel worthy and loved.

Yet this feeling of enough-ness will never come from others. We may feel liked and valued for a while, but striving for worth is a vicious cycle that always calls for more. A little more work. A little more makeup. A little more money. A little more studying.

The truth is, we will never be perfect in the eyes of the people around us…because we are not perfect. And they are not perfect.

We carry around invisible satisfaction surveys and, gauging everyone around us, silently (and maybe subconsciously) rate ourselves based on our perception of their perception of us. I bet that person would give me a ‘1’ on promptness. He would give me a '10’ on friendliness. She would give me a ‘5’ on fashion sense. No wonder we’re stressed out and exhausted!

Toxic environments lead to sickness and death. In my case, it led to deepened depression and anxiety. For others it may manifest in physical sickness, anorexia, addiction…

Getting Out

Ironically, it’s when we stop caring too much about what others think that our relationships improve. When we direct all our energy toward pleasing others, we forfeit the opportunity to do our best work. It takes great courage to admit that we are not enough, and great humility to admit that we can never be enough. But there is freedom if we can embrace the truth that because God is enough, we don’t have to be enough.

When we believe this, we shift from operating from a place of frantic striving to a place of confidence in God’s enough-ness. We operate from a stable place rather than from a place where success is defined by others or even by ourselves. We are able to focus on doing our best rather than exhausting ourselves attempting to achieve perfection. We are able to be instead of do, and out of just being come our gifts to the world—the gifts that so often get squelched in our efforts to please others: our compassion for our patients, our ability to motivate our students, our passion for our workplaces, our unique skills and talents for serving and creating and inspiring.

Good News

The bad news is that we live in a society that embraces the HCAHPS approach to life. Regardless of whether or not you work in a hospital, I imagine that all of our workplaces have a tinge of the HCAHPS approach, subtle or blatant.

We may not be able to change society completely—or hospital reimbursement policy—but the good news is that we do not have to keep the HCAHPS approach as our approach to life. We can replace it with the liberating approach of recognizing our need and operating from a sufficiency outside of ourselves. Somehow, when our internal approach shifts, it doesn’t matter so much that the people around us—at work, at school, or at home—are hung up on performance and people pleasing. 

They can post it on a wall I see every day at work, but they cannot post it on my heart. I choose to leave the HCAHPS approach behind. What about you?

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